Study results show that psychiatric emergency department visits and repeat visits among children are on the rise

Visits to the emergency room and repeat visits to children’s hospitals linked to mental health are “increasing rapidly,” a new study suggests.

According to the study, published Tuesday in the journal JAMA Pediatrics, between 2015 and 2020, mental health visits to pediatric emergency departments increased by 8% per year, with about 13% of those patients returning for a return visit within six months. In contrast, all other emergency department visits increased by 1.5% annually.

Mental health revisits increased by 6.3% annually, but in general, the percentage of mental health visits that resulted in a revisit remained stable, “which may indicate that those with the revisit are increasing.” Attendance-related factors did not change significantly during the study period, even as the pediatric mental crisis worsened,” wrote the researchers from Children’s Hospital Los Angeles, the University of Southern California and Boston Children’s Hospital.

“However, the significant increase in the sheer number of revisits is still worrying,” the researchers added in their study.

The study’s findings suggest that both visits and repeat visits to the pediatric psychiatric emergency department are increasing, “and identifying patients at high risk of recurrence provides an opportunity for tailored interventions to improve mental health care.”

The new study included data from more than 200,000 patients treated at 38 children’s hospitals across the United States between October 1, 2015 and February 29, 2020. The data comes from the Pediatric Health Information System, an administrative database of children’s hospitals.

Researchers looked at how many visits included diagnoses of mental health disorders or intentional self-harm. They also analyzed repeat mental health visits, meaning that a patient returned to the emergency department within six months of their first visit.

The continued increase in visits to the pediatric mental health emergency department could be linked to “a combination of factors, including a worsening pediatric mental illness crisis and a shortage of psychiatric clinicians,” the researchers wrote.

The most common diagnoses at psychiatric emergency room visits were suicidal ideation or self-harm, accounting for 28.7% of patients; mood disorders in 23.5%; anxiety disorders in 10.4%; and disruptive or impulse control disorders at 9.7%.

The data showed that 13.2% of psychiatric emergency room visits were revisited within six months. Patients with diagnoses related to behavioral disorders, including disorder or impulse control disorders, neurodevelopmental disorders, and psychotic disorders, were at highest risk for a repeat visit. Patients with substance use disorders were less likely to return to the emergency department.

“With teenage fentanyl overdose deaths more than doubling from 2019 to 2021, just released by the CDC, it worries me that we may only get one opportunity to intervene and make this one highly vulnerable.” To help population group that we urgently need to keep”, pediatrician Dr. Scott Hadland, chief of adolescent and adolescent medicine at the Mass General for Children and Harvard Medical School, who was not involved in the new study, wrote in an email to CNN.

The trend of increasing visits and repeat visits to the pediatric psychiatric emergency department is in line with what frontline healthcare providers are seeing — even before the Covid-19 pandemic, Hadland said.

“We absolutely see this increase. I run our primary care clinic for teenagers in Boston, and on a typical day at the clinic, more than four out of five teenagers I see struggle with mental health issues,” he said. “We know that Covid has socially isolated many young people, keeping them away from school and other activities important to their healthy development. As a result, rates of the same mental health problems are likely even higher now.”

Hadland added that there is a growing need for improved access to youth mental health services and better funding to sustain those services.

“Because our mental health systems are so strained that there is a shortage of psychiatrists and therapists to work with adolescents, pediatricians like me are increasingly having to fill those roles,” Hadland said, adding that without more support and resources, the country could potentially move on to see mental health patients being revisited in the ER. Study results show that psychiatric emergency department visits and repeat visits among children are on the rise

Laura Coffey

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